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Type 2 diabetes--which BGLs matter?--The fasting, pre- and post-prandial glycaemia debate
Patrick J Phillips1, Stephen M Twigg
1Department of Endocrinology, The Queen Elizabeth Hospital, South Australia. patrick.phillips@nwahs.sa.gov.au
Background:
There is vigorous debate about the relative importance of targeting fasting blood glucose levels (BGLs) and postprandial BGLs.
Objective:
This article assesses the contribution of pre- and post-prandial BGLs to overall glycaemia and provides a practical strategy for improving overall glycaemia in patients on insulin.
Discussion:
In most patients who need to commence insulin therapy, the A1c is 8.0% or more. At these levels, fasting and other premeal BGLs contribute more to the A1c than does postprandial BGL. The higher the A1c, the more important the fasting and premeal BGLs. The 'keep insulin safe and simple' (KISS) approach is useful when starting insulin in type 2 diabetes.
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